Racism breeds trauma. What happens when mental health care makes it worse?


Over the past year, we have witnessed America struggle to confront its deep-rooted legacy of racism.

Images of police brutality against Black people have been deemed newsworthy. The world is getting a front row seat to the injustices that have been faced by Black people for decades. This is compounded by the fact that Black families have disproportionately mourned the losses of loved ones to COVID-19. The unemployment rate for Black Americans is over 1.4 times higher than the national average. Black people’s wages are significantly lower, too.

These harsh realities have taken a toll on some Black people’s mental health. Even when Black treatment-seekers gain access to mental health care, many have to deal with the systemic racism that pervades the discipline.

It’s becoming increasingly urgent that we address health inequity and remake our mental health infrastructure in the name of equity and justice.

It’s difficult to look at the yawning racial disparities in mental health diagnosis, treatment and outcomes and not conclude that there is a problem. Black mothers are more likely to suffer from postpartum depression than white mothers yet they’re less likely to receive treatment.

Black teenagers are 50 percent more likely than white teens to develop symptoms of bulimia. Yet, clinicians are far more likely to identify disordered eating symptoms as problematic in white patients than in Black ones.

Compared to the population as a whole, Black patients are also less likely to be offered either medication therapy or psychotherapy from a mental health professional. Two studies from 2016 found that therapists were less likely to give appointments to new Black patients than new white ones.

These inequities are even more troubling considering the unique mental health challenges Black Americans face, largely as a result of historical adversity and socioeconomic disparities rooted in racism. Black adults are more likely to experience feelings of sadness, hopelessness and worthlessness than their adult white counterparts. Black teenagers, meanwhile, are more likely to attempt suicide than white teens.

In other words, systemic racism not only undermines Black mental health, it impedes access to quality, timely mental health care — and thereby exacerbates the psychological costs of this societal ill.

One cause of these inequities is the lack of diversity in the mental health profession. According to the American Psychological Association, 84 percent of the nation’s psychologists are white. Yet demand for mental health professionals from non-white populations is projected to grow by 24 percent by 2030.

Though a good starting point, promoting more diversity in the psychological profession will only do so much. What’s needed is a broader understanding of the complex ways in which racism shapes mental health care.

Since our nation’s earliest days, psychology has been used to promote notions of Black inferiority and justify everything from slavery to segregation to mass incarceration. Even today, the amount of behavioral science devoted specifically to Black, Indigenous, and people of color remains rare. When these populations are studied, the research tends to include white comparison groups. Whiteness is deemed the norm, which means Black people are understudied in evaluating methods and ideas for treatment.

So let’s chart a new course. Let’s prioritize research that focuses on Black Americans — and does justice to the uniqueness, complexity, and diversity of Black experiences.

We also need to change the way we educate mental health professionals. It’s still far too common for future doctors to learn — whether explicitly or implicitly — that racial health disparities are the result of cultural pathologies and personal choices, not structural forces like racism.

As long as these ideas remain dominant, racial health disparities — including in mental health outcomes — will only persist.

We must also normalize nontraditional forms of care. There’s more to mental health care than psychotherapy and prescription drugs. By embracing the value of practices such as mindfulness, peer support training, and self-care in achieving wellness, we can change the character of our mental health system in ways that benefit Black Americans and other non-white groups.

Let’s also encourage conversation. On May 25, my company, Healthline, is hosting a virtual town hall featuring mental health advocates like actress Taraji P. Henson and singer Michelle Williams that aims to encourage dialogue across communities and dismantle the stigma surrounding mental health. Good mental health is a collective endeavor. We can all play a role in each other’s healing.

Our mental health infrastructure has failed Black Americans and compounded the psychological costs of systemic racism. We must confront these failings — and chart a course to a more equitable mental health system.

Faye McCray is Editor in Chief of Psych Central (psychcentral.com), a Healthline Media publication.